Peak Expiratory Flow as a Surrogate for Health Related Quality of Life in Chronic Obstructive Pulmonary Disease: A Preliminary Cross Sectional Study

Background: Health Related Quality of Life (HRQL) measures can capture the non-respiratory effects of Chronic Obstructive Pulmonary Disease (COPD). However the relationship with Peak Expiratory Flow (PEF) is not well understoodAim: To determine the relationship of PEF and quality of life measurements in patients with COPD Settings and Design: A cross section of consecutive patients in a university clinicMethods: Stable patients with COPD defined by the Global Initiative on chronic Obstructive Lung Disease (GOLD) criteria, were recruited into the study. Spirometry was done using American Thoracic Society’s standards and  reference equations from African American norms of the US population. Quality of life was measured with the St George’s Respiratory Questionnaire (SGRQ)Results: Out of 50 patients recruited for the study, 48 provided complete data with acceptable spirometry and PEF data. The mean (SD) age and body mass index was 68.4 (8.9) years and 21.4 (4.6) kg/m2 respectively and 96% of the patients were in moderate-severe stages of COPD using the GOLD criteria. Percent predicted PEF correlated with percent predicted FEV1; r= 0.559 p<0.001 and also showed a significant, though moderate correlation between PEF readings and SGRQ scores especially in the activity (r= -0.455 p< 0.01) and total scores (r=-0.415 p<0.01) for pre bronchodilator (BD) percent predicted PEF. In regression analysis, PEF was associated with SGRQ (-0.11 95% CI -0.19, -0.03) after adjusting for age, sex, height, smoking and disease severityConclusions: PEF correlates with SGRQ scores and may be a useful surrogate for HRQL in patients with COPDKey words: Peak expiratory flow, quality of life, spirometry, primary car

Unmet needs in asthma treatment in a resource-limited setting: Findings from the survey of adult asthma patients and their physicians in Nigeria

Introduction: The prevalence of asthma in our society is rising and there is need for better understanding of the asthma patients’ perception andtreatment practice of physicians. The study was aimed at determining asthma attitudes and treatment practices among adult physicians andpatients in Nigeria, with the goal of identifying barriers to optimal management.Methods: To assess asthma attitudes, treatment practices and limitations among adult physicians and patients in Nigeria, a questionnaire survey was conducted among 150 patients and 70 physicians.Results: Majority (66.7%) of the patients reported their asthma as  moderate to severe, 42.7% had emergency room visit and 32% had admission due to asthma in the previous 12 months. Physicians and patients perceptions significantly differed in the time devoted to  educational issues (31.4% vs.18.7%) and its contents: individual  management plan (64.3% vs.33.3%), correct inhaler technique (84.0% vs.71.0%), medication side effects (80.0% vs.60.0 %) and compliance 100% of time (5.7% vs. 18.7%). Patients reported that non-compliance with medication causes increased symptoms (67.0%), exacerbations (60.0%), bronchodilator use (56.0%), urgent physician visit (52.0%) and hospitalizations /ER visits (38.7%). Asthma medication in patients caused short term (10.7%) and long term side effects (20.0%). Due to side  effects, 28.0% skipped and stopped their medications. Most physicians (85.7%) and patients (56.0%) agreed on the need for new medication options. The need for new medication in patients was strongly related to asthma severity, limitation of activities, side effects, cost and lack of satisfaction with current medication. With the exception of pulmonologists, physicians did not readily prescribe ICS and their prescriptions were not in line with treatment guidelines.Conclusion: This study has highlighted the gaps and barriers to asthma treatment which need to be addressed to improve the quality of care in Nigeria

Severity Assessment of Lower Respiratory Tract Infection in Malawi: Derivation of a Novel Index (SWAT-Bp) Which Outperforms CRB-65

OBJECTIVE: To assess the validity of CRB-65 (Confusion, Respiratory rate >30 breaths/min, BP<90/60 mmHg, age >65 years) as a pneumonia severity index in a Malawian hospital population, and determine whether an alternative score has greater accuracy in this setting. DESIGN: Forty three variables were prospectively recorded during the first 48 hours of admission in all patients admitted to Queen Elizabeth Central Hospital, Malawi, for management of lower respiratory tract infection over a two month period (N = 240). Calculation of sensitivity and specificity for CRB-65 in predicting mortality was followed by multivariate modeling to create a score with superior performance in this population. RESULTS: Median age 37, HIV prevalence 79.9%, overall mortality 18.3%. CRB-65 predicted mortality poorly, indicated by the area under the ROC curve of 0.649. Independent predictors of death were: Male sex, “S” (AOR 2.6); Wasting, “W” (AOR 6.6); non-ambulatory, “A” (AOR 2.5); Temp >38°C or <35°C, “T” (AOR 3.2); BP<100/60, “Bp” (AOR 3.7). Combining these factors to form a severity index (SWAT-Bp) predicted mortality with high sensitivity and specificity (AUC: 0.867). Mortality for scores 0–5 was 0%, 3.3%, 7.4%, 29.2%, 61.5% and 87.5% respectively. A score ≥3 was 84% sensitive and 77% specific for mortality prediction, with a negative predictive value of 95.8%. CONCLUSION: CRB-65 performs poorly in this population. The SWAT-Bp score can accurately stratify patients; ≤2 indicates non-severe infection (mortality 4.4%) and ≥3 severe illness (mortality 45%)

Respiratory symptoms and ventilatory function tests in Nigerians with HIV infection

Background: The impact of the human immunodeficiency virus (HIV) infection on the respiratory system of Africans has been little studied. This study aimed to determine the pattern of respiratory symptoms and ventilatory functions in HIV infected Nigerians. Methods: In this cross sectional study, Respiratory symptoms frequency, Forced vital capacity (FVC), Forced expiratory volume in one second (FEV 1 ), FEV 1 /FVC ratio, Forced expiratory flow between 25% and 75% of FVC, were determined in 100 HIV positive subjects and compared with values in 100 HIV negative controls. Results: HIV positive patients had significantly more respiratory symptoms and lower ventilatory function tests values compared to the matched controls (p<0.05). HIV patients with at least one respiratory symptom and those with CD4 count less than 200cells/μl had lower ventilatory function values than their counterparts. 32% of the HIV patients had restrictive ventilatory functional impairment. (p<0.05). Using regression analysis, factors like HIV status, CD4 count and presence of respiratory symptoms were found to be associated with impairment in ventilatory functions. Conclusions: HIV infected patients had more frequent respiratory symptoms and lower ventilatory function values. Further lung function studies and CT scanning in HIV positive patients especially in those with respiratory symptoms are indicated

Secondhand smoke exposure among non smoking adults in two Nigerian cities

Background: Tobacco control policy can only succeed if the burdens of smoking are known. The objective of this study was to determine the prevalence and correlates of secondhand smoke (SHS) exposure among nonsmoking adults in two Nigerian cities. Materials and Methods: We carried out a cross-sectional study from October 2009 to April 2010 among adult population of two Nigerian cities: Enugu and Ilorin. A semi-structured questionnaire was administered by interviewers to obtain socio-demographic information; and information regarding pattern of SHS exposure, awareness of tobacco control policy and the harmful effects of SHS. SHS exposure was defined as regular exposure to tobacco smoke in the previous 30 days in a nonsmoking adult. Results: Of the 585 nonsmoking adults that completed the study, 38.8% had regular exposure to SHS; mostly, in public places (24.4%). More men were exposed at public places when compared with women (27.0% vs. 19.5%). The strongest factor associated with exposure to SHS in women was having a smoking spouse [prevalence rate (PR) ratio-7.76; 95% confidence interval (CI), 3.08-9.42]; and in men, it was lack of home smoking restriction (PR ratio-6.35; 95% CI, 4.51-8.93). Among men, SHS exposure at any location was associated with lack of secondary school education, residing in slum apartment (house with many households), living with a smoking family member (non-spouse), lack of home smoking restriction, and alcohol intake. Among women, SHS exposure at any location was associated with having a smoking spouse, residing in slum apartment and lack of home smoking restriction. Seventy-two percent of respondents were aware of the harmful effects of SHS on their health. Lack of awareness of the harmful effects was significantly associated with increasing age (r= +0.45; P